Risk of acquiring COVID-19 infection, severe COVID-19 infection and severe pneumonia
The overall pooled analysis of nine studies indicated insignificant association between the risk of acquiring COVID-19 infection and the use of ACEIs/ARBs (OR: 1.01; 95%CI: 0.93, 1.10), ACEIs (OR: 1.13; 95%CI: 0.9, 1.42), or ARBs (OR: 0.56; 95%CI: 0.11, 2.89) (Figure 5; Table 3). The sub-group analyses results were consistent with overall analyses results for ACEIs/ARBs and ACEIs (Supplementary file 5A; Supplementary file 5B; Table 4) but there were inconsistent for ARBs with a significantly lower risk of acquiring COVID-19 with ARBs among non-peer-reviewed studies, good quality studies and studies which reported crude measure of effects (OR: 0.24; 95%CI: 0.17, 0.34) (Supplementary file 5C; Table 4). Similarly, in a pooled analysis of seven and two studies, insignificant association was observed between the risk of developing severe COVID-19 infection, severe pneumonia, respectively, and ACEIs/ARBs (OR:0.78; 95%CI: 0.53, 1.15; OR:1.29; 95%CI: 0.24, 6.96), ACEIs (OR: 0.72; 95%CI: 0.26, 1.95) or ARBs (OR: 0.51; 95%CI: 0.25, 1.04) (Figure 6; Table 3), regardless of any sub-group analysis (Supplementary file 6; Table 4).